| Summit Gastroenterology Pllc | |
|
309 Regency Pkwy Ste 101 Mansfield TX 76063-5165 | |
| (682) 400-2153 | |
| (972) 572-2228 |
| Full Name | Summit Gastroenterology Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 309 Regency Pkwy Ste 101, Mansfield, Texas |
| Authorized Official Name and Position | Sunitha Pudhota (OWNER) |
| Authorized Official Contact | 6824002153 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Gastroenterology Pllc 309 Regency Pkwy Ste 101 Mansfield TX 76063-5165 Ph: (682) 400-2153 | Summit Gastroenterology Pllc 309 Regency Pkwy Ste 101 Mansfield TX 76063-5165 Ph: (682) 400-2153 |
| NPI Number | 1114355385 |
|---|---|
| Provider Enumeration Date | 10/24/2013 |
| Last Update Date | 05/29/2019 |
| Medicare PECOS PAC ID | 0840411104 |
|---|---|
| Medicare Enrollment ID | O20141030000327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114355385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | P1484 (Texas) | Primary |
| Provider Name | Sunitha G Pudhota |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1952362980 PECOS PAC ID: 2668406927 Enrollment ID: I20120130000669 |
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